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PubMed2004

[A case of cerebral putaminal hemorrhage complicating a brain abscess proved by craniotomy].

A 40-year-old man was admitted to our hospital because of consciousness disturbance, dysarthria and numbness in his right hand. Computed tomography of the head showed a cerebral hemorrhage of the left putamen. The patient was judged to have an indication of operation, and frontal craniotomy to evacuate hematoma was performed. During the operation, massive whitish pus flowed out at the time of surgery. Therefore, hemorrhage into a brain abscess was diagnosed. We reported this unique and interesting case whose brain abscess could not be differentiated from an ordinary hypertensive putaminal hemorrhage based on clinical findings and CT image. This diagnosis was not made until the patient was operated on through a craniotomy.

Adult↗
PubMed2005

[Sequentially occurred bilateral atlantoaxial rotatory subluxation following craniotomy: a case report].

Atlanto-axial rotatory subluxation (AARS) often presents in childhood as a stiff, painful neck with associated typical cock-robin type of torticollis. It can occur spontaneously or following minor trauma or an inflammatory process in the cervical tissues or following otorhinolaryngeal surgery. We report a case of bilateral AARS which occurred sequentially following craniotomy. To the best of our knowledge, no case of AARS after craniotomy has been reported previously and only one case in which bilateral AARS was observed has been reported to date. Failure to recognize the condition may result in a fixed rotatory subluxation, which can be difficult to treat. Awareness of this condition by surgeons involved in brain surgery should lead to its early recognition and treatment, preventing a fixed deformity occurring. We discuss the clinical presentation and management of AARS. The literature on this subject is briefly reviewed.

Astrocytoma↗
PubMed2005

Acute massive pulmonary hemorrhage after craniotomy in a patient with systemic lupus erythematosus.

Acute massive pulmonary hemorrhage (AMPH) is a rare life-threatening complication of systemic lupus erythematosus (SLE). We report a lupus nephritis patient with active disease, in whom AMPH developed after craniotomy for brain injury. Computed tomography scan of the brain revealed a subdural hemorrhage and intracranial hemorrhage with a midline shift, indicating increased intracranial pressure (IICP). Neurogenic pulmonary edema (NPE) was suspected 5 days after operation due to dyspnea and chest radiograph findings of bilateral infiltrations. Seven days after the craniotomy, she had bloody sputum, a sudden drop in blood hemoglobin level (from 12.3 g/dL to 8.8 g/dL), and diffuse alveolar infiltrates in both lung fields. All of these features were characteristic manifestations of AMPH. Complete blood count disclosed mild thrombocytopenia (88,000/mm3). We believe that in an SLE patient, IICP or NPE might be risk factors in the development of AMPH.

Craniotomy↗
PubMed2005

[A case of organized chronic subdural hematoma showing an early recurrence after craniotomy].

A 64-year-old man who had undergone single burr hole drainage twice prior to this admission was hospitalized with a recurrent right chronic subdural hematoma. A head CT showed a mixed density subdural hematoma on the right frontotemporoparietal region. Based on the intraoperative findings of the previous surgeries, the hematoma was known to be organized. Therefore, we decided to do a small craniotomy under general anesthesia, and remove the organized subdural hematoma and thick outer membrane while leaving the thickened dura matter intact. The inner membrane was left untouched. One week later, despite adequate decompression, the hematoma recurred with midline shift on head CT. It is likely that the uniquely thick and vascular enriched outer membrane and dura contributed to such an early recurrence. Finally, we performed an extensive craniotomy, removing all the organized hematoma, outer membrane and dura. Again, the inner membrane was left intact. On one year follow-up the patient has been asymptomatic with complete resolution of the subdural hematoma on CT scan. The successful treatment of organized chronic subdural hematoma can be challenging. We strongly recommend an extensive removal of the organized hematoma, outer membrane and excision of the dura mater in order to achieve a successful outcome after failed burr hole evacuation.

Craniotomy↗
PubMed1992

[Single craniotomy by trephining and closed-circuit external drainage for the treatment of chronic subdural hematoma].

Chronic subdural hematoma is one of the most frequent pathological entities in the adult. Therapeutic approaches have ranged from craniotomy with excision of the membrane to close external drainage placed, under local anesthesia, at the bedside. The authors report the results of treatment of twelve (12) patients by craniotomy with placement of a closed external drainage for the gradual emptying of the chronic subdural hematoma.

Aged↗
PubMed2006

[Comparison of anesthetic maintenance and recovery with propofol versus sevoflurane combined with remifentanil in craniotomy for supratentorial neoplasm].

OBJECTIVE: To compare the effectiveness of propofol versus sevoflurane associated with remifentanil on the maintenance of anesthesia and on recovery in patients undergoing elective supratentorial craniotomy. PATIENTS AND METHODS: Prospective randomized trial enrolling 90 patients scheduled for excision of a brain neoplasm. All received an infusion of remifentanil at a dose of 0.5 microg x Kg(-1) x min(-1) until tracheal intubation and then 0.25 microg x Kg(-1) x min(-1) during surgery. Induction was achieved with propofol and anesthesia was maintained with either sevoflurane at a maximum alveolar concentration of 0.4 (45 patients) or propofol by target controlled infusion at a concentration of 2.5 microg x mL(-1) (45 patients, group P). Variables assessed were hemodynamic stability during anesthesia and times and quality of recovery from anesthesia (eye opening, initiation of spontaneous ventilation, extubation, cough reflex, and temporal and spacial orientation 3 minutes after extubation. During the first 24 hours after surgery, pain intensity was evaluated on a verbal visual analog scale (VAS) and the incidence of nausea and vomiting was recorded. RESULTS: Times until eye opening upon request and until extubation were significantly shorter in the sevoflurane group than in the propofol group: 3.7 (SD, 1.2) minutes vs 5 (3.1) minutes, respectively, for eye opening and 6.6 (1.2) minutes vs 8.1 (3.3) minutes for extubation (P<0.01). The incidence of nausea and vomiting was significantly higher in the sevoflurane group (40% vs 13%, respectively, P<0.01). CONCLUSIONS: Combining remifentanil with propofol or with sevoflurane provides satisfactory anesthesia during elective supratentorial craniotomy to remove a brain neoplasm. Hemodynamic stability is appropriate and recovery from anesthesia is rapid.

Anesthesia↗
PubMed2006

[Comparison of curative effect and analysis of influencing factors in patients with basal ganglion hemorrhage treated with traditional craniotomy and mini-invasive operation].

OBJECTIVE: To compare the curative effect of traditional craniotomy and mini-invasive operation on basal ganglion hemorrhage, and analyze influencing factors related to the differences. METHODS: Fifty-five cases with basal ganglion hemorrhage according with the enrollment criterion of standardized treatment of hemorrhagic stroke were analyzed. Twenty-eight cases were treated with mini-invasive operation (mini-invasive group) and 27 cases with traditional craniotomy (craniotomical group). The evaluation indexes included postoperative complications, consciousness in 3 days and 2 weeks after operation, and activity of daily life (ADL) in 3 months after operation. SPSS 10.0 software was used for statistical analysis. RESULTS: Three days after operation, 19 cases and 10 cases of abnormal consciousness were in craniotomical group and mini-invasive group, respectively (P<0.01). Seventeen cases had pulmonary infection and/or organ dysfunction in craniotomical group, and 11 cases in mini-invasive group (P<0.05). Three months after operation, 5 cases were in vegetable status and 3 died in craniotomical group, accounting for 29.6%, while 3 cases were in vegetable status and 2 died in mini-invasive group, accounting for 17.8% (P<0.05). No difference in ADL was found in the two groups with an exception of cases of vegetable status and death (>0.05). CONCLUSION: mini-invasive operation makes the abnormal consciousness recover earlier, reduces complications, vegetable status and mortality and has no obvious effect on recovery of neurological function.

Basal Ganglia Hemorrhage↗
PubMed1992

Perioperative care of the craniotomy patient: a review.

1. Knowledge of the patient and the planned positioning allows the perioperative nurse to prepare for the needs of the individual craniotomy patient in surgery. 2. Microsurgical instrumentation often required with a craniotomy requires special handling and care. 3. Methylene blue should never be used in neurosurgical procedures. 4. The sitting position for posterior fossa surgery requires special precautions.

Craniotomy↗
PubMedDate not supplied

[Fronto-temporo-sphenoidal craniotomy using the Yasargil method in operations of aneurysms and expanding lesions of basal areas of the brain].

The authors describe in detail the technique of fronto-temporo-sphenoidal craniotomy of Yasargil and stress its advantages in surgical treatment of aneurysms of the circle of Willis. This method was used in surgical treatment of 82 patients with intracranial aneurysms, expanding lesions situated in the vicinity of the sella and ala parva of the sphenoid bone, and with other intracranial processes, and very good conditions for operation were obtained. The authors believe that fronto-temporo-sphenoidal craniotomy is the most favourable approach for the management of aneurysms of the circulus arteriosus.

Circle of Willis↗
PubMed1979

[Decompressive craniotomy in herpes simplex encephalitis].

Two patients with herpes simplex encephalitis (HSE) underwent decompressive craniotomy with brain biopsy. The indication for the procedure was in both cases computertomographic finding of a large, space-occupying process situated in the temple lobe with clinical picture involving febrile state, progressive hemiparesis, and subconsciousness. The patients were treated with standard doses of Ara A and methylprednisolone immediately after operation. In both cases, the improvement was very impressive. The massive neurological deficits -- in one case even including subtotal aphasia -- disappeared almost completely in the weeks following operation. 6 months later both patients underwent cranioplasty. These observations show that decompressive craniotomy with dilatation of the dura represents a decisive therapeutic approach in the case of HSE when the pressure of the brain cannot be brought under control by medical treatment. Computertomography proved to be of particular diagnostic value and assists in taking decisions for meaningful surgical treatment.

Adult↗
PubMed1995

[Convulsive seizure after craniotomy--comparison of isoflurane anesthesia and sevoflurane anesthesia].

The incidence of postoperative convulsive seizure was compared retrospectively during either isoflurane or sevoflurane anesthesia in patients after craniotomy. Overall, 5 of a total of 125 patients suffered convulsive seizures after craniotomy: 2 (4%) of 45 patients with isoflurane anesthesia and 3 (4%) of 80 patients with sevoflurane anesthesia. No significant differences were observed between these two groups. The duration of anesthesia and duration of the MAC.h were similar between these two groups. The occurrence of postoperative convulsive seizure was not related with the inhalational anesthetic agents, the underlying disorders and patient characteristics. It is suggested that either isoflurane or sevoflurane anesthesia in neurosurgical patients may have no specific relationship with the postoperative convulsive seizures.

Adult↗
PubMed1995

Mannitol increases cerebral arteriovenous oxygen difference in patients undergoing craniotomy.

BACKGROUND: Monitoring the jugular venous oxygen saturation (SjVO2) and cerebral arteriovenous oxygen difference (AVDO2) is valuable in detecting cerebral ischemia. In the present study, we investigated the effect of mannitol on SjVO2 and AVDO2 in patients undergoing craniotomy. METHODS: We studied 25 ASA class II-III patients undergoing craniotomy. Anesthesia was induced with thiopental, fentanyl and vecuronium. Immediately after induction, a 16-gauge central venous catheter was placed in the internal jugular vein, ipsilateral to the lesion side with cephalic insertion and anchorage in the jugular bulb. Anesthesia was maintained with continuous infusion of fentanyl (10 micrograms/kg/h), 0.5-1% isoflurane in 60% oxygen (oxygen/air) and supplemental dose of vecuronium for muscle relaxation as needed. Samples of arterial and jugular venous blood were obtained for the measurements of SjVO2 and AVDO2 in the following time intervals: (1) normocapnia (PaCO2 38-40 mmHg); (2) hypocapnia (PaCO2 28-30 mmHg); and (3) 30 min after mannitol (0.5 g/kg) infusion. RESULTS: Hyperventilation resulted in a significant decrease in SjVO2 (96% patients) and increase in AVDO2 (88% patients). Hypocapnia followed by mannitol administration led to a further decrease and increase of SjVO2 and AVDO2 in 72% and 68% patients, respectively. CONCLUSIONS: Mannitol may produce a further reduction in SjVO2 accompanied by an increase in AVDO2, suggesting a reduction of cerebral blood flow (CBF) during hyperventilation. Therefore, it should be given cautiously in neurosurgical patients under hyperventilation.

Adult↗
PubMed1994

Length of hospital stay and contributing variables in supratentorial craniotomy patients with brain tumour: a pre-care map study.

The study included 70 patients admitted to Neurosurgical ICU (NICU) with the diagnosis of Supratentorial Craniotomy for Brain Tumour. These patients were followed throughout their hospitalization in NICU, to the ward and until discharge from hospital. The purposes of the study were (a) to indicated the NICU and floor length of stay (LOS) in this group of patients, prior to the use of care map and compare it to a developed care map, and (b) to identify the variables that contribute toe overall prolonged hospital LOS. The findings indicated that, prior to the use of care map, 68.8% of Supratentorial Craniotomy Patients with Brain Tumour had an ICU LOS of one day. However, only 38.6% of these patients were discharged from hospital within the care map indicated 5 day post ICU, floor LOS. The findings also showed that the overall hospital LOS, in 71.4% of the patients, was over 7 days, as indicated on the developed care cap. Several variables such as patient complications, consults, rehab/placement, patient falls and additional diagnostic tests contributed to the overall pronged hospital LOS. Thus, by monitoring these variables with the use of a care map, may produce measurements to evaluate cost effectiveness, and allow health care professionals to provide more effective and quality patient care.

Adult↗
PubMed1994

[Clipping of aneurysm arising from the posterior communicating artery itself by contralateral craniotomy: a case report].

A case of aneurysm arising from the posterior communicating artery itself clipped by contralateral frontotemporal craniotomy (pterional approach) is presented. A 65-year-old female developed sudden severe headache and chest pain in January of 1993. Neurological examination on admission revealed consciousness disturbance such as stupor and nuchal stiffness. CT-scan showed marked subarachnoid hemorrhage. She also suffered from acute myocardial ischemia and cardiac failure. Cerebral angiograms after recovery from cardiac dysfunction demonstrated three saccular aneurysms arising from the dilated right posterior communicating artery itself, the junction of the left internal carotid artery and the posterior communicating artery, and the bifurcation of the left middle cerebral artery. The left IC-PC junction aneurysm was thought to be ruptured because of its size and contour, so left frontotemporal craniotomy was undertaken. By the left pterional approach, successful clipping of all three aneurysms involving the one arising from the contralateral posterior communicating artery was achieved. The aneurysm at the posterior communicating artery itself was found to arise from the non-branching site and to project inferiorly, thus the successful clipping through the prechiasmal cistern could be performed without compromising any small perforating arteries.

Aged↗
PubMed1994

[A study on combined acupuncture and enflurane anesthesia for craniotomy].

The reinforcing effect of transcutaneous acupoint electric stimulation (TAES) with enflurane anesthesia during craniotomy was studied. 110 neurosurgical patients were randomly divided into three groups. Anesthesia was maintained with enflurane in group A (n = 40); in group B, enflurane anesthesia was supplemented by TAES with Han's acupoint nerve stimulator (HANS) at Hegu, Yuyao and Fengchi points on the operated side (n = 40); in group C, enflurane anesthesia was supplemented by TAES and scalp infiltration with 0.5% procaine (n = 30). The results showed that the minimum alveolar concentration (MAC) of enflurane in group B and C decreased 37.8-47.0% and 42.1-66.1% respectively than that in group A. The hemodynamics was more stable during operation, and the patients recovered faster after operation in group B and C. It was concluded that TAES with HANS significantly potentiated the anesthetic effect and decreased the side effects of enflurane during operation, and that the triple combination of TAES, enflurane and scalp infiltration with procaine proved to be a better anesthetic method for craniotomy.

Acupuncture Analgesia↗
PubMed1994

[Contralateral epidural hematoma following the craniotomy for intracerebral tumor--one case report and review of literature].

A 40-year old female patient suffered from headaches for 2 months. Two days before admission, the headache got worse and vomiting and seizures followed. Brain CT scans revealed a right frontal intracerebral tumor. So she received a craniotomy to remove the tumor, which was verified as glioblastoma multiforme. The postoperative course was uneventful. However, headaches attacked again two weeks later. An epidural hematoma on the left parietooccipital region was found on brain CT scans. The craniotomy was done to remove the hematoma and no abnormal vessels or inflammation was seen in the operative field. This was the first such case we had encountered. We review the literature and discuss possible factors related to this case.

Adult↗
PubMed1994

Technical modifications to the middle fossa craniotomy approach in removal of acoustic neuromas.

With the increased use of gadolinium-enhanced magnetic resonance imaging studies to detect acoustic neuromas, smaller tumors are discovered more frequently. The middle fossa craniotomy approach for removal of small tumors is ideal for hearing preservation. The authors report hearing preserved at or near the preoperative levels in 71 percent of a series of 24 consecutive patients in whom the middle fossa craniotomy approach was employed. Several technical modifications, including more extensive bony exposure medially, tumor dissection in a medial-to-lateral direction, and topical application of papaverine to the cochlear nerve at the modiolus, have enhanced the ability to preserve hearing.

Adolescent↗
PubMed1995

Post-operative analgesia for craniotomy patients: current attitudes among neuroanaesthetists.

As part of an evaluation of post-operative analgesia for craniotomy patients, a postal questionnaire was sent to 183 consultant members of the Neuroanaesthesia Society of Great Britain and Ireland, inquiring about their current practices for post-operative neurosurgical analgesia. Replies were received from 110 neuroanaesthetists in 37 different neurosurgical centres. Intramuscular codeine phosphate or dihydrocodeine was the mainstay of post-operative analgesia for 97% of neuroanaesthetists despite the fact that over half of them thought that analgesia was inadequate. Only four neuroanaesthetists would ever consider using opioids post-operatively because of fears about respiratory depression and sedation, yet all except one used opioids per-operatively. Post-operative analgesia for craniotomy patients is perceived as inadequate by most neuroanaesthetists, yet traditional prejudice against opioid use prevents this being remedied. We suggest that patient-controlled analgesia with morphine could be a safe alternative to codeine phosphate.

Analgesia↗